Cerebral venous thrombosis: a changing landscape

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke and is mainly a disease of the young. The aims of the study were to summarize the change in the clinical profile of CVT and provide an update regarding the current management of the same. A literature search was conducted using Pubmed and Google scholar using the desired terms. Studies were analysed and review was formulated. The median age of CVT in most studies was 32 years. There has been a shift from female pre-ponderence to equal gender predilection. Several studies are confirming the efficacy of D-dimer as a diagnostic marker of CVT. Newer oral anticoagulants have been found to be as efficient as warfarin. There have been several cases of CVT reported in association with COVID-19. This review confirmed the traditional understanding of age and risk factors of CVT. It also noted a change from the female pre-ponderence. NOACS are emerging as the preferred drug for the long-term management of CVT

Effect of Curing Methods And Environment on Properties of Concrete

The paper presents the effect of three different curing methods i.e. water curing, sealed curing , air curing and curing periods on  different concrete mixes on hardened properties of fly ash concrete and ordinary cement concrete at different regions in India in varied conditions of temperature, humidity and wind. The results showed that the strength of water & sealed cured samples are comparable. The behaviour of concrete against improper curing  is same for concrete with and without flyash. The relative values of Rapid Chloride Penetration Test (RCPT) are lowest for water cured samples but no correlation could be established on absolute values. For a given  design mix when range of temperature variation during curing period is high, effect is seen in compressive strength and  when a humidity variation is high, effect is seen in RCPT values

Ising Ferromagnet: Zero-Temperature Dynamic Evolution

The dynamic evolution at zero temperature of a uniform Ising ferromagnet on a square lattice is followed by Monte Carlo computer simulations. The system always eventually reaches a final, absorbing state, which sometimes coincides with a ground state (all spins parallel), and sometimes does not (parallel stripes of spins up and down). We initiate here the numerical study of ``Chaotic Time Dependence'' (CTD) by seeing how much information about the final state is predictable from the randomly generated quenched initial state. CTD was originally proposed to explain how nonequilibrium spin glasses could manifest equilibrium pure state structure, but in simpler systems such as homogeneous ferromagnets it is closely related to long-term predictability and our results suggest that CTD might indeed occur in the infinite volume limit.Comment: 14 pages, Latex with 8 EPS figure

A study of prevalence of peripheral neuropathy in patients with impaired glucose tolerance

Background: It is estimated that about half of the diabetics develop diabetic peripheral neuropathy (DPN). Prediabetes is the precursor of type 2 diabetes and it is projected that by 2045 nearly 8.6% of the global adult population may be affected by prediabetes. Pre diabetics also shares the vascular complications of diabetes. Evaluation of impaired glucose tolerance (IGT) and its association with neuropathy is hence very essential. According to International Diabetes Federation, number of global impaired glucose regulation (IGR) patients will reach 471 million by 2035. It is imperative that management strategies aimed at timely diagnosis and prevention of these complications be framed.Methods: 30 patients with IGT were recruited from outpatient/inpatient department of JSS hospital who met the following WHO diagnostic criteria (HbA1C of 5.7-6.4%, fasting blood sugar of 100-125 mg/dl, oral glucose tolerance test (OGTT) 2-hour blood sugar of 140-199 mg/dl) were included in the study. All the patients underwent nerve conduction studies as per the established clinical practice and results were compared with the standard values of our laboratory.Results: 13 patients (43.33%) had neuropathy based on nerve conduction studies (NCS). Sensory neuropathy (53.85%) was most common followed by motor and mixed types with 3 patients each (23.08%).Conclusions: Prevalence of neuropathy was high in prediabetics. Small fibre involvement as manifested by sensory component was predominant in our study. Family history of diabetes was an important risk factor associated with higher neuropathy prevalence.

Study of insulin resistance as an inflammatory marker for ischemic stroke severity among non-diabetics

Background: Insulin resistance (IR) is emerging as an important modifiable risk factor causing acute ischemic stroke. The purpose of the study was to evaluate insulin resistance among patients of acute ischemic stroke, in non-diabetic patients, and to correlate insulin resistance with the severity of acute ischemic stroke, and to observe its association with traditional risk factors. Methods: It was a prospective study conducted at JSS Medical College, Mysore, India from September 2021 to December 2022. Patients who presented with the history of stroke, who were non-diabetics and aged >18 years were included with informed consent. Ischemic stroke was diagnosed with clinical findings and by neuroimaging. Stroke severity was assessed by NIHSS score. Homeostasis model assessment (HOMA) was used to estimate insulin resistance and the levels were studied in relation to the stroke severity. Results: A total of 127 non-diabetic ischemic stroke patients were enrolled in the study. Hyperinsulinemia, i.e. serum insulin >9 μU/mL, was observed in 44 (34.64%) patients. IR with HOMA-IR ≥2.5 was noted in 39 (30.7%) patients. NIHSS score in severity (group III) was strongly associated with serum insulin >9 μU/mL (62.1%) (P = 0.001) and HOMA-IR ≥2.5 (62.1%) (P<0.0001). Conclusions: Screening for insulin resistance in nondiabetic patients with ischemic stroke may identify those who are at higher risk for poor outcomes, allowing for early intervention and closer monitoring. Also, interventions to reduce insulin resistance, such as lifestyle modifications or medications, may be beneficial in improving stroke outcomes

Neuropathy in the setting of alcoholism-an entity less thought of

Disulfiram is a commonly used adjunctive treatment in the management of alcohol dependency.  It has been noted that disulfiram can induce peripheral neuropathy, the mechanism of which has not been clearly determined. A 35-year-old patient, reformed alcoholic, on disulfiram presented with complaints of painful distal dysesthesias and foot drop. Clinical examination revealed bilateral foot drop without any objective sensory loss. Patient was evaluated for the same and routine blood investigations including vitamin B-12, inflammatory and virological markers were found to be normal. Nerve conductions studies revealed in excitable bilateral common peroneal and tibial nerves. Possibility of disulfiram induced peripheral neuropathy was thought of and drug was withdrawn. Patient was followed up and after two months improvement in motor power and reduction in paraesthesia’s was noted. Disulfiram is a commonly used drug, the uncommon side effect of which is distal predominant axonal neuropathy. This must be kept be kept in mind when evaluating a patient presenting with features of peripheral neuropathy, on a background of alcohol abuse

Zero Temperature Dynamics of 2D and 3D Ising Ferromagnets

We consider zero-temperature, stochastic Ising models with nearest-neighbor interactions in two and three dimensions. Using both symmetric and asymmetric initial configurations, we study the evolution of the system with time. We examine the issue of convergence of the dynamics and discuss the nature of the final state of the system. By determining a relation between the median number of spin flips per site, the probability p that a spin in the initial spin configuration takes the value +1, and lattice size, we conclude that in two and three dimensions, the system converges to a frozen (but not necessarily uniform) state when p is not equal to 1/2. Results for p=1/2 in three dimensions are consistent with the conjecture that the system does not evolve towards a fully frozen limiting state. Our simulations also uncover `striped' and `blinker' states first discussed by Spirin et al., and their statistical properties are investigated.Comment: 17 pages, 12 figure

Sialoglycan recognition is a common connection linking acidosis, zinc, and HMGB1 in sepsis

© 2021 the Author(s). Published by PNAS. This open access article is distributed under Creative Commons Attribution License 4.0 (CC BY). https://creativecommons.org/licenses/by/4.0/Blood pH is tightly maintained between 7.35 and 7.45, and acidosis (pH <7.3) indicates poor prognosis in sepsis, wherein lactic acid from anoxic tissues overwhelms the buffering capacity of blood. Poor sepsis prognosis is also associated with low zinc levels and the release of High mobility group box 1 (HMGB1) from activated and/or necrotic cells. HMGB1 added to whole blood at physiological pH did not bind leukocyte receptors, but lowering pH with lactic acid to mimic sepsis conditions allowed binding, implying the presence of natural inhibitor(s) preventing binding at normal pH. Testing micromolar concentrations of divalent cations showed that zinc supported the robust binding of sialylated glycoproteins with HMGB1. Further characterizing HMGB1 as a sialic acid-binding lectin, we found that optimal binding takes place at normal blood pH and is markedly reduced when pH is adjusted with lactic acid to levels found in sepsis. Glycan array studies confirmed the binding of HMGB1 to sialylated glycan sequences typically found on plasma glycoproteins, with binding again being dependent on zinc and normal blood pH. Thus, HMGB1-mediated hyperactivation of innate immunity in sepsis requires acidosis, and micromolar zinc concentrations are protective. We suggest that the potent inflammatory effects of HMGB1 are kept in check via sequestration by plasma sialoglycoproteins at physiological pH and triggered when pH and zinc levels fall in late stages of sepsis. Current clinical trials independently studying zinc supplementation, HMGB1 inhibition, or pH normalization may be more successful if these approaches are combined and perhaps supplemented by infusions of heavily sialylated molecules.Peer reviewe

Metastability in zero-temperature dynamics: Statistics of attractors

The zero-temperature dynamics of simple models such as Ising ferromagnets provides, as an alternative to the mean-field situation, interesting examples of dynamical systems with many attractors (absorbing configurations, blocked configurations, zero-temperature metastable states). After a brief review of metastability in the mean-field ferromagnet and of the droplet picture, we focus our attention onto zero-temperature single-spin-flip dynamics of ferromagnetic Ising models. The situations leading to metastability are characterized. The statistics and the spatial structure of the attractors thus obtained are investigated, and put in perspective with uniform a priori ensembles. We review the vast amount of exact results available in one dimension, and present original results on the square and honeycomb lattices.Comment: 21 pages, 6 figures. To appear in special issue of JPCM on Granular Matter edited by M. Nicodem